This is a new activity in FY07. It links to access to home water treatment and basic hygiene counseling (# 6630) and basic palliative care programs of the US university partners (# 5618, # 5770, # 5772, and # 1057).

People living with HIV/AIDS should be offered a basic care package regardless of stage of HIV disease or eligibility for antiretroviral therapy. The use of safe water is one element of this basic package. Point of use safe water is one of the components of the preventive care package developed by PEPFAR Ethiopia.

A safe water supply has been shown to reduce diarrheal illness in children by 20%. Water treatment and safe storage at the point-of-use has been shown to reduce diarrhea prevalence by 25% and the number of days ill from diarrhea by 33% in PLWHA.

As part of the preventive care package, PEPFAR Ethiopia began supporting a safe water system project at hospital, health center and community level in FY06. The project targets persons visiting urban and peri-urban hospitals, and peri-urban and rural health centers within selected ART Health Networks.

This activity will support interagency technical assistance in the implementation, monitoring and evaluation of the safe water system project at all levels of the health care system. It will use CDC's prior experience in Uganda, Kenya, Nigeria and Botswana in implementing projects aimed at reducing diarrheal diseases and providing safe water through collaborations with organizations delivering care to PLWHA.

In addition to providing technical assistance as described above, CDC will also: (1) Conduct a KAP survey related to water, sanitation, and health, including point-of-use water treatment (2) Analyze monthly sales of WuhaAgar disinfectant data to look for trends and assess where to focus more intensive efforts (3) Perform a distribution survey to assess commercial availability of WuhaAgar disinfectant (4) Evaluate the safe water system program in Ethiopia by using a combination of these techniques to assess its impact

This is a new activity in the area of Human Capacity Development aimed at introducing and implementing the Sustainable Management Development Program to improve the management and training skills of public health management professionals, health service planners and managers in Ethiopia. The SMDP/MIPH Course is offered as a TOT program every fall in Atlanta, Georgia, USA. The course is developed in collaboration with Emory University and international development agencies to help ministries of Health in over 61 developing countries to strengthen their public health management capacity through: conducting a comprehensive situation analysis( management skills and performance gaps, working with stakeholders and counter parts from local training institutions, to create an action plan for faculty development and institution-building that includes a budget, timeline, and measurable outcomes) , train participants a broad variety of public health management skills, including practical exercises and innovative training techniques, providing fully developed training materials for practical use in their own country training programs, and also providing technical assistance to the trained professional/SMDP/MIPH graduates in conducting in-country training needs assessments, developing locally appropriate curricula, planning in-country workshops and supervising applied management learning projects that provide a practicum for the trainees.

Accordingly, a couple of professionals from Ethiopia have been trained in SMDP/MIPH. How ever, due to various constraining factors, SMDP/MIPH has not been implemented in Ethiopia. Apart from technical subject areas trainings catered during pre-service education at Universities, Medical Colleges and Schools, most Public Health Planners and Managers do not have the opportunity to attend intensive in-service/on-the-job trainings like the SMDP/MIPH to enhance their health service management roles and responsibilities at health facilities and central/regional offices. This has been a felt gap at all levels (facility, local, regional and national) in Ethiopia.

In 2007, PEPFAR Ethiopia plans to implement this need-based and innovative training program in Ethiopia.

The objectives of the project among others are to: 1) implement applied management learning projects in ART cohort hospitals, that results in measurable improvements in ART and other care delivery services in Ethiopia and 2) strengthen collaboration with USG Universities through follow-up and capacity enhancement in the implementation of SMDP/MIPH trainings at health facilities, local universities, the Ministry, Regional Health Bureaus and HAPCO offices.

As regards the implementation mechanism, PEPFAR Ethiopia will closely work with CDC-Atlanta/SMDP and JHPIEGO-E as well as the MOH, RHB, HAPCOs, USG Universities and Local Universities as well as PEPFAR Hospitals in the design, organization, management, delivery and follow-up of the SMDP Training program in Ethiopia.

The major activities under this project are: 1) conducting needs assessment 2) analyzing data 3) developing a customized curriculum for SMDP TOT Program in Ethiopia and trainees selection criteria 4) conducting the training 5) establishing trainers core team at national, regional and facility levels, and 6) conducting post-training follow-up and supervision.

Since the USG, Health Facilities, Local Universities and Training Institutions will actively involve in the process of needs assessment, customization of the SMDP/MIPH training materials to the Ethiopian settings and Health Workforce development, planning and management of Public health services, the training will be sustained and institutionalized at local health facilities and Training Institutions. In line with this plan, 30% of the required budget will be expended on needs assessment and training materials design with technical assistance of consultants from CDC-Atlanta, 50% on the training materials production, delivery and management including establishment of core training team and 20% 0n follow up of the training programs application at the health Facilities and Local Universities and Training Institutions.

Public Awareness on ART

This is a continuing activity from FY06 and relates to ART Program Implementation Support 5658; 5661; 5664; 5666)

CDC/E with ARC and Walta Information Center will be undertaking public awareness activities at national regional level in collaboration with ART implementing partners. Implementation of plans during the first three months of COP06 is well on track. The funding level for FY07 is the same as for FY06 and the current objectives are consolidation of gains , and further scale up to enhance the demand for ART services with particular emphasis on rural settings.

With the fast scale-up of ART services in Ethiopia and the rapid decentralization of the national program, awareness generation among the general public as well as selected high risk groups is becoming a critical intervention to enhance and optimize the use of the services at various outlets. PEPFAR Ethiopia has successfully initiated collaboration with the media, mainly with Walta Information Center, a leading media center in the country, to undertake public awareness activities through the media and regional symposia at national and regional levels targeting policy makers, program managers, religious leaders, care providers and clients. PEPFAR Ethiopia and its partners are working on scaling-up awareness generating activities on ART and, by end of FY06 plan period, include various forms of promoting public awareness activities related to ART services in Ethiopia. These will be evaluated at the end of the plan period and required adjustments made.

In FY07, public awareness activities will be consolidated and further scaled up to enhance the demand for ART services as well as increase ART service uptake, with particular emphasis on rural settings. This will immensely contribute to national regional efforts to break the epidemic from expanding from urban and peri-urban areas to rural areas where 85% of the Ethiopian population resides. Experience gained in generating general awareness about HIV/AIDS in major cities across the country will be used to organize campaigns and occasions such as workshops and symposia to generate awareness about the ART program

The experience gained by Walta Information center, which received support, as a sub-partner, will be used to scale up media activities though different communication channels using target specific materials and methods. The support to Walta will be strengthened to enable the Center undertake program activities. The AIDS Resource Center, with an enhanced support from PEPFAR Ethiopian, will develop appropriate materials for perusal by Walta and other partners, in awareness generation activities. AIDS Resource Center and Walta will develop detailed work plans for implementation of the ART Communication Strategy Guidelines developed in FY06 through the support from PEPFAR Ethiopia. This will be operational in close collaboration with other partners on the ground and with different Regional Health Bureaus to ensure local ownership and address specific regional contexts. To support the implementation of Guidelines, ARC and Walta will ensure that proper information on ART is available at the regional and woreda levels.

In COP07, the ART sites will increase to 131 hospitals and 240 health centers. This will constitute a huge and rapid scale up of ART services, which are duly complex given the country's context. The scale of service expansion will require concomitant increase in awareness among providers and clients across in the country and, most importantly, among the rural population. Along with the expansion of the ART, intensive work will be done to increase the utilization of the services. AIDS resource center will continue to support material development to meet regional needs, with due consideration give to cultural and language differences. AIDS Resource Center and Walta will link their activities with different USG and non-USG partners, particularly with those working in different regions of the country.

The AIDS Resource Center and Walta Information Center will involve other local organizations with proven experience of developing and disseminating awareness generation activities including mass campaigns. They will collaborate with the US universities and other implementing partners to organize and implement public awareness campaigns on ART. Implementation will be intensified and cover the whole country, including the emerging regions where ART activities are currently started in one or two

hospitals and utilization of ART services is low. Awareness campaigns will involve national and local media, mini-medias and other forms of promotional activities, using various local languages.

As part of their responsibilities in FY07, ARC and Walta will organize and provide training on awareness enhancement in ART programs, build the capacity of MOH and HAPCO at various levels. MOH and HAPCO will be actively supported to lead activities related to this project so that in-country capacity is built to undertake immediate implementation needs as well as sustain the activities in the long term. In collaboration and linked with the Community Planning Project and other partners on the ground, ARC and Walta will build the capacity of leaders at various levels, including community leaders and PLWHA associations to support activities that enhance ART access and up-take. Technical support will also be provided to strengthen ART program activities in hospitals and assist treatment adherence initiatives. The activities outlined above will enhance demand and increase effective uptake of the fast expanding ART services in urban and rural settings. It is estimated to add to ART targets by about 11,000 patients and hence will contribute to overall PEPFAR Ethiopia's ART targets for FY07 and subsequent plan period.

Laboratory Infrastructure These are continuing activities from COP05 and COP06. As of April 2006, CDC Ethiopia has received 100% of COP06 funds and is on track regarding program implementation according to the original targets/work plan for Ethiopia. In COP07, funding has been decreased by 40% because some activities have been transferred to other sections and other prime partners. CDC Ethiopia, in collaboration with major stakeholders, is working to strengthen the regional and hospital laboratories to increase capacity to support new efforts towards care and treatment and scale up of ART. Comprehensive support including, training, furnishing with major laboratory equipment, lab supplies and renovation works at national, regional and hospital laboratories is being provided. CDC Ethiopia successfully supported comprehensive renovation and furnishing of laboratory, ART, VCT, and PMTCT sites in four ART hospitals and one regional laboratory. In addition, the renovated HIV laboratory at EHNRI has been furnished with equipment, a laboratory information system and made ready to serve as a national center of excellence to support HIV care and treatment,

During COP05 and COP06, CDC Ethiopia played a major role in coordinating all laboratory- related activities for HIV/AIDS prevention, care, and treatment programs. Among other activities, the HIV drug resistance threshold survey was successfully accomplished in partnership with EHNRI and Israeli National HIV Reference Laboratory. Because of this effort, Ethiopia became one of the few African countries to complete the national HIV drug resistance threshold survey. Survey results showed no major drug resistance in Addis Ababa where ARV treatment was initiated more than five years ago.

To improve the performance of laboratory services, laboratory monitoring and evaluation tools have been developed in collaboration with MOH/EHNRI and US universities. Standard laboratory request, reporting, and referral forms were developed and are being used at all levels.

For supporting diagnosis and monitoring of ARV, essential laboratory equipment (chemistry, hematology, FACS-Count machines, fridge/freezers, incubators, sterilizers, PCR machines and accessories, biosafety hoods and other minor equipment and supplies) were purchased and distributed to ART sites. CDC Ethiopia coordinated activities with GF/MOH and supported distribution and installation of laboratory equipment purchased by GF/MOH for 62 ART hospitals.. Logistic and technical support were provided to all ART hospital laboratories and laboratory monitoring service provided to more than 100,000 Pre-ART patients in care and more than 40,00 patient on ARV therapy at 88 hospitals.

In COP07, the following activities will be accomplished. (1) Supporting the co-management of National HIV laboratory at EHNRI. CDC co-management of Ethiopia's National HIV Reference laboratory is planned to achieve the following objectives: maximize results for the CDC-EHNRI collaborative activities; establishment and maintenance of a national laboratory that meets international standards in Ethiopia; use of this laboratory as the model to demonstrate, train for, and accelerate the establishment of national laboratory quality system nationally and regionally including quality assurance; effectively coordinate and implement the laboratory support to the national antiretroviral treatment program; enhance the country's capacity for disease surveillance, outbreak investigation, and drug resistance monitoring; develop local laboratory capacity and promote technology and knowledge transfer; and sustain targeted evaluations in critical health issues of interest to Ethiopia

For improving the effectiveness and quality of laboratory services the following activities will be supported: evaluation of new diagnostic and monitoring tools; simple and point of care technology for CD4 count, introduction of simple HIV viral load assay for monitoring treatment failures; and development of in-house method for cost effective monitoring of HIV drug resistance. This primarily is accomplished in collaboration with Israeli National HIV Reference laboratory. The initial collaboration was successful and resulted in completion of HIV drug resistance threshold survey.

(2) Technical assistance. CDC Ethiopia will provide technical assistance to MOH/EHNRI to establish a quality-assured network of tiered laboratory services nationwide. CDC will be closely involved with implementing partners (ASCP, APHL and EHNRI) in providing and following up national, regional, and site level trainings. Support will be provided in

development and distribution of guidelines, SOPs, and laboratory monitoring and evaluation tools including laboratory requisition and referral forms and overall assessments of laboratory services.

(3) Supportive supervision and QA program at regional, hospital and health center laboratories. Through periodic supervision of regional reference laboratories, hospital and health centers, PEPFAR Ethiopia will closely follow the progress, monitor and evaluate the laboratory performance. The activities will be linked with Ethiopian Health and Nutrition Research Institute (EHNRI) and regional reference laboratories.

Added February 2008: CDC-Ethiopia provides support for the national laboratory infrastructure development. Technical assistance will be provided to EHNRI to establish a quality-assured network of tiered laboratory services nationwide. CDC will work for establishment and maintenance of a national laboratory that meets international standards in Ethiopia. This laboratory will be used as the model to demonstrate, train for, and accelerate the establishment of national laboratory quality system nationally and regionally including quality assurance; effectively coordinate and implement the laboratory support to the national antiretroviral treatment program; enhance the country's capacity for disease surveillance, outbreak investigation, and drug resistance monitoring; develop local laboratory capacity and promote technology and knowledge transfer; and sustain targeted evaluations research in critical health issues of interest to Ethiopia. Small amount of budget was reprogrammed to CLSI to initiate important gap filling activities for the laboratory program in Ethiopia.

Expansion of Laboratory Information System

This activity is an ongoing activity from COP06.

In COP06 under this activity support was provided to six regional laboratories and nine PEPFAR supported hospital laboratories with laboratory Information Management System, computer hardware and accessories. PEPFAR Ethiopia will work together with the Association of Public Health Laboratories (APHL) and continue supporting and providing the Implementation and expansion of LIMS.

In COP07, this activity will expand the laboratory information system to 26 sites to support operations and quality assurance activities in EHNRI, regional laboratories and PEPFAR supported ART hospital laboratories. It will also enable sites to have an efficient data and report exchanges. To achieve this, the following expansion work will be accomplished: (1) procurement of additional 78 LIMS software site licenses for 26 sites; (2) procurement of 26 barcode printers, 78 barcode readers and 52 barcode printer papers; (3) training of 52 laboratory technicians and 26 receptionists in LIMS; (4) Procurement and provision of 78 computers and accessories; (5) design and implement peer-to-peer network for selected regional and hospital laboratories; (6) installation and configuration of LIMS in selected regional and hospital laboratories and link the hospital laboratories via dial-up with their respective regional laboratories, and regional laboratories with EHNRI reference laboratory; (7) installation of telephone lines into regional and hospitals laboratories for successful implementation of LIMS; (8) provide technical support to COP06 funded LIMS sites; and (9) local travel for technical support and international travel for experience sharing with APHL facilities on LIS.

Added July 2007 Reprogramming: In COP07, this activity will expand the laboratory information system to 26 sites to support operations and quality assurance activities in EHNRI, regional laboratories and PEPFAR supported ART hospital laboratories. It will enable sites to have efficient data and report exchanges. To achive this, the following expansion will occur: 1) procurement of 78 additional LIMS software licenses for 26 sites, 2) procurement of 26 barcode printers, 78 barcode readers and 52 barcode lables, 3) training of 52 laboratory technicians and 26 receptionists in LISM, 4) procurement and provision of 78 computers and accessories, 5) design and implementation of a peer-to-peer network for selected regional and hospital laboratories, 6) installation and configuration of LIMS in selected regional and hospital laboratories, linking the hospital laboratories via dial-up with their respective regional laboratories, and regional laboratories with EHNRI reference laboratory, 7) installation of telephone lines into regional and hospital laboratories for LIMS successful implementation, 8) continue technical support to COP06 funded LIMS sites, 9) local travel for technical support and international travel for experience sharing with APHL facilities on LIMS.

Support to the National TB/HIV Information System

This is a new activity for FY07. This activity is linked with the national M&E (5582), the data warehouse (COP ID 5724) and other TB/HIV activities of the partners (5750, 5751, 5752, 5754 and 5749) supported by PEPFAR. This activity will also be strengthening the implementation of the national HMIS.

According to the WHO Global TB Control Report issued in 2006, Ethiopia ranked 8th out of the top 22 High TB Burden Countries in terms of total number of tuberculosis cases notified in 2004, which was 123, 127. The estimated incidence of all forms of tuberculosis and pulmonary tuberculosis was 353 and 154/100,000 populations, respectively. The case detection rate of PTB+ cases was 36%, nearly half the global target of 70%. Cure rate for pulmonary tuberculosis cases on DOTS was 54% in 2004, falling short of the global target by 31%.

Information on prevalence of co-infection in Ethiopia is very limited and is based on very few hospital based surveys. The TB/HIV collaborative work was initiated in Ethiopia as a pilot project at 9 sites at the end 2004. Based on the experience from these sites the collaborative work has scaled up to 61 hospitals in the last one year. The data generated from these TB/HIV implementing sites revealed 47.5% co-infection.

The TB/HIV reporting system is designed by the MOH to follow the tuberculosis reporting system and is separately handled from other diseases. The quarterly reporting of statistics on patients diagnosed with TB/HIV is done at the woreda, zonal, regional level and at central level; epidemiological and operational indicators for monitoring of the program are calculated and compiled. Quarterly reporting is done according to the Ethiopian fiscal year.

Proper monitoring and evaluation of the TB/HIV activities is critical not only for effective management of individuals but also and more importantly to keep track of trends of the co-epidemics and facilitate subsequent planning. The MOH in its revised third edition of the TB/Leprosy guideline and first edition of TB/HIV implementation guideline clearly indicated on how to record and report the TB/HIV data and the monitoring and evaluation mechanisms of the TB/HIV activities. Although M&E activities are implemented to a certain extent a number of challenges that require remedial action are observed in the last one year. PEPFAR assisted evaluation of the TB/HIV implementing sites was conducted a year ago and the following drawbacks were observed 1) poor data recoding and reporting as a result of poorly organized monitoring and evaluation system 2) shortage of human resource 3) inadequate supervision, 4) lack of knowledge and 5) absence of electronic data management system.

This project aims to support the national tuberculosis control program which is functioning as a lead in the TB/HIV collaborative initiative at MOH and is chairing the TB/HIV Advisory Committee.

In 2007, activities will build on what has been started and focused on strengthening the TB/HIV monitoring and evaluation by (1) revising the TB and HIV registers according to feedbacks received from implementing sites and to include any missing indicators; (2) developing a data system at national, regional and district level to systematize the reporting and analyze the TB/HIV surveillance data, which includes training of MOH and regional staff on data management, procurement of IT equipments, recruiting staff, and other logistical support; (3) conducting regular supportive supervision to implementing sites; and (4) conducting review meetings involving all stakeholders on a regular interval, and external evaluations.

Strengthening National HIV/AIDS/STI Surveillance Systems

This is an ongoing activity which was started in 2002 and continued to date. This activity is linked to the National M&E System Strengthening and Capacity Building (5582, 1090, 1094, and 5714). No FY06 funds have yet been received. The partner has just finalized the FY05 activities and targets as planned and based on plans of the EHNRI/FMOH/HAPCO for expanding the non-ANC and ANC based HIV surveillance activities, and will extend technical assistance to the government.

The uses of strategic information including data generated from surveillance programs has been crucial for the proper design, planning, implementation and monitoring and evaluation of HIV/AIDS prevention, care and support, and treatment programs supported by PEPFAR Ethiopia. Proper and timely estimations of the incidence, prevalence and impacts of HIV/AIDS and other related opportunistic infections among different geographic areas and population groups would help PEPFAR Ethiopia to influence the design and implementation of relevant policy guidelines; set specific, measurable, achievable, realistic and time bound program targets; and focus its resources on the most productive areas in the fight against the epidemic.

In COP06, PEPFAR Ethiopia supported the regular collection, processing, and analysis of surveillance data from sources including HIV counseling and testing services, TB/HIV and STI treatment clinics using guidelines that were developed in 2005. PEPFAR Ethiopia also continued to assist regions and the MOH in their use of surveillance data for planning, implementation and monitoring and evaluation of prevention, care and support and treatment programs. National HAPCO/ MOH and RHB were also assisted in planning their surveillance activities for the 2007 round of sentinel site HIV surveillance and making procurements including equipment and supplies for all the sites.

Moreover, PEPFAR Ethiopia supported EPHA with supplemental funds for the collection, compilation, processing, analysis, reporting and dissemination of data from the AIDS Mortality Surveillance in Addis Ababa. The determination of HIV incidence using BED and ARV drug resistance surveillance was also finalized in 2006 in close collaboration with the laboratory team.

In COP07, support will be provided to conduct the 2007 round of the ANC based HIV surveillance. The activity will be conducted in 100 ANC sentinel sites. The additional 21 sites will be selected from underrepresented rural areas in consultation with the RHB. The systematic collection, analysis and utilization of data from PMTCT services that are being supported by PEPFAR Ethiopia will also be supported to strengthen the surveillance system. This activity will help to generate strategic information on HIV/AIDS from PMTCT programs in health institutions that are fairly distributed all over the country. Available data capturing and reporting tools and mechanisms will be reviewed and improved.

PEPFAR will continue to support the collection, processing and utilization of surveillance data from sources including HIV counseling and testing, as well as TB/HIV, STI and blood donor services.

From the 2005 round of ANC based HIV surveillance and the 2005 EDHS+ survey, we have learned that the epidemic in the country consistes of very different sub-epidemics in terms of rural-urban and regional distributions. There are regions that seem to be driving the country's epidemic and that have rural sites with persistently high HIV prevalence rates over the last surveillance rounds. The 2005 ANC surveillance also revealed that the prevalence of syphilis among the ANC attendees showed an increasing trend unlike that of HIV. Moreover, both the Behavioral Surveillance Survey and EDHS+ did not provide data on the level of HIV and HIV related risk behaviors among the most at high risk groups. In COP07, a biological (both HIV and syphilis) and behavioral surveillance survey will be conducted among population groups including commercial sex workers, long distance truck drivers, prisoners, street people, out of school youth, men having sex with men and intravenous drug users. The objective of this activity is to look at the situations of the epidemic in regions with rural sites reporting persistently high HIV and syphilis prevalence rates, and obtain information on the most at high risk groups. The survey will also identify the roles these population groups have played in the high prevalence rates in these areas. The results of these surveys will be used to support the design, planning and

implementation of programs focusing on these population groups. This will help PEPFAR Ethiopia and the government focus their efforts and resources on targeted interventions.

The capacities of EHNRI, HAPCO/FMOH, RHB and surveillance sites will be further strengthened so to enable them conduct the planning, implementation, monitoring and evaluation of surveillance programs effectively and efficiently. To effect this, surveillance program management as well as specific surveillance-related trainings will be provided to national, regional and site level surveillance program officers and coordinators. These interventions will improve the leadership and technical skills. PEPFAR will also support the preparation and distribution of strategic information (international and country) to the EHNRI, NHAPCO/FMOH, RHB, all ART site hospitals and their satellite health centers.

Plus ups: Monitoring and evaluation of palliative care activities is undeveloped in Ethiopia, despite OGAC provision of guidelines. There is currently no standardized method of collecting and reporting palliative care data across partners at national level. This lack ranges from the definition of palliative care indicators, data collection tools, reporting formats to data transfer and use mechanisms. Palliative care services, an essential component of HIV care and treatment programs, must be properly documented, and their impact measured and reported accurately. CDC will assess the current reporting system, pilot test proposed indicators, and based on this evaluation the country palliative care monitoring system will be designed. As PEPFAR reports are aggregated across partners, a standardized way of collecting and reporting indicators is essential to provide an accurate account of reality.

Table 3.3.13:

This activity only includes direct hire salaries, contractors, and technical support contracts.

Required Skills: Requirements for short-term success: program management, budget, finance, acquisition and post-award management and supply chain management; project development informed by evidence-based best practices; participatory strategic planning based on sound data; effective interagency, donor, intergovernmental, and partner relations; large-scale TA and capacity building focusing on community and stakeholder involvement, social and behavioral interventions, private sector engagement, and health service expansion at all levels and across all sectors. Requirements for long-term success and sustainability include: technical, administrative, and leadership capacity building for indigenous partners; results-based project management with ongoing monitoring and evaluation; and exit strategies for continued funding, long-term access to TA, close-out and hand-over of projects.

Current Staffing: CDC staffing includes management support and technical staff to implement evidence-based and technologically sound programs and to support implementation of projects by a large number of indigenous partners. Direct hires and contractors are used to provide leadership that otherwise would not be available in the local market. Local staff members have key roles in assisting partners with project implementation and providing administrative support. We have experienced some turnover and difficulty in recruiting due to changes in the job market resulting in increased competition. We are actively recruiting to fill vacant positions.

Reprogrammed and New Positions: To address our current staffing needs, we first reviewed existing positions. Ten existing positions were reprogrammed. The two contract positions for technical officers in BCC and PMTCT were cancelled. These duties will be covered by existing local positions. The PEPFAR Ethiopia Collaborative Team agreed that the CDC USDH for prevention was not needed. The USAID position will provide leadership in this area. In SI, the PSC was cancelled in favor of a direct hire. The associated costs are similar. This was done to enhance recruitment. With regards to local staffing which is included in the management and staffing base budget, we reprogrammed six positions to meet our current skills requirements. We have abolished the writer editor position; these services will be provided as part of a larger communications contract. The duties for the Associate Director for Regional Affairs have been assumed by the US-based universities as part of the regionalization strategy. One of the international universities has taken the lead and is working with PLWHA. The PLWHA technical officer position has been abolished. We also abolished three administrative positions. In the long run, it is more cost effective to contract for some of the lower graded administrative positions. As the need for these services increase, we will consider contracting. This effort also supports our post right-sizing efforts.

In this budget, we are requesting direct hire or contract positions for the following: Laboratory infrastructure-PEPFAR is the only foreign entity supporting Ethiopia technically in the development of the national, regional and facility-based laboratory capacity to support programmatic services including counseling and testing, PMTCT, TB/HIV, and ART programs; surveillance including national antenatal care-based surveillance, ARV and gonorrhea drug resistance surveillance; and monitoring and evaluation including quality assurance programs. We are supporting laboratories at 89 hospitals and over 300 health centers. Therefore, we are including a laboratory technical lead/USDH.

The laboratory USDH will provide leadership to the laboratory team and TA to the National and Regional Reference Laboratories, hospital labs and health center laboratories. The position requires an individual with experience in molecular diagnosis, laboratory program management, quality assurance, excellent interpersonal and communication skills, the ability to work with a variety of professionals from diverse backgrounds, and working knowledge of health care delivery systems in resource-scarce settings.

Partner Management and capacity building: We are increasing the number of indigenous partners directly funded by PEPFAR. Most of these partners require assistance with their management practices. As CDC require our partners to prioritize capacity building of local organizations, There is a need to coordinate those efforts to ensure the sustainability of HIV/AIDS programs. Most of the indigenous partners require assistance with management practices, including their business systems and other USG project

management requirements. We will also ensure that local USG staff have the capacity to assist in fulfilling USG requirements for contracts and grants monitoring. We are requesting a USDH public health advisor to develop and implement the partner management and capacity building aspects of our programs. After two years, the leadership for partner management will transferred to the local program coordinator. This position requres knowledge of HIV/AIDS public health programs and mastery of the theories, concepts, principles, practice, methods, and techniques of public health program administration; knowledge of USG policies, procedures, and regulations to manage and oversee funds and a variety of procurement mechanisms and awards; knowledge of a wide range of qualitative and quantitative methods to review, evaluate, and improve publich health program operations and implementation; the ability to plan, organize, and direct team activities; ability of communicate, both orally and in writing, to make clear, convincing presentation, explain and justify recommendations, represent PEPFAR programs, provide guidance and advise executive leadership, respond to inquiries, and interact with high level officials and representatives from the public and the private sector.

Management: As a whole, PEPFAR Ethiopia lacks a plan for both internal and external communications. We would like to have a comprehensive PEPFAR Ethiopia communications strategy that represents all agencies at post. The strategy will guide us in terms of health communications, media relations, events planning, etc. This strategy will be "owned" by the Public Diplomacy Workgroup and integrated into the mission-wide strategy through collaboration with the Public Affairs Section. In addition, CDC has experience difficulty in recruiting a skilled writer. We are requesting a communications advisor to support the PEPFAR communications strategy and lead the communications activities within CDC. They will develop original documents and serve as editor for documents produced by the technical staff. They will serve on the PD Workgroup and liaise with the Public Affairs Section for both CDC and PEPFAR. This position will reduce the workload that PEPFAR has placed on the Public Affairs Section. The position requires knowledge of principles, theories, practices, techniques, terminology and expressions of health communications; skill in reviewing, editing, and rewriting journal articles, book chapters, training manuals, and other materials for internal and external publications and coordination of production of major length projects; knowledge of effective graphic and tabular display of data; skill in identifying material unsuitable for publication because of poor expression, incomplete coverage, inappropriate style and format, or imbalance of material. This position replaces the Associate Director for Regional Affairs. The duties of that position have been distributed amongst the US university partners.

Table 3.3.15:

Cost of Doing Business

This activity includes ICASS and CSCS taxes. CDC subscribes to full ICASS services. The estimated cost of FY07 ICASS charges is $600,000. CSCS charges are included for 78 desk positions and 21 non-desk positions. This tax is approximately $1,380,000.

Table 3.3.15: